Provider Demographics
NPI:1235369182
Name:CHOICES HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:CHOICES HEALTH CENTER, INC.
Other - Org Name:CHOICES HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-456-1047
Mailing Address - Street 1:747 FAWN RIDGE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8268
Mailing Address - Country:US
Mailing Address - Phone:386-456-1047
Mailing Address - Fax:866-707-3476
Practice Address - Street 1:747 FAWN RIDGE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8268
Practice Address - Country:US
Practice Address - Phone:386-456-1047
Practice Address - Fax:866-707-3476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-24
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7157261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004619500Medicaid
CE573AMedicare UPIN
FL004619500Medicaid